Surgical instrument with end-effector assembly including three jaw members

ABSTRACT

A surgical device includes an elongated shaft having an end-effector assembly at a distal end thereof. The end-effector assembly includes first, second and third jaw members. The first and second jaw members controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member disposed therebetween, to a second position, wherein the first, second and third jaw members cooperate to grasp tissue therebetween. The surgical device also includes a knife operatively coupled to the elongated shaft. A channel defined along a length of an upper surface of the third jaw member is configured to slideably receive a portion of the knife therein.

CROSS REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S. Provisional Application Ser. No. 61/910,657, filed on Dec. 2, 2013, the entire contents of which are incorporated herein by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical instruments such as electrosurgical and ultrasonic devices. More particularly, the present disclosure relates to surgical instruments that include an end-effector assembly including first and second jaw members capable of applying a combination of mechanical clamping pressure and energy to effectively seal tissue and a third jaw member disposed between the first and second jaw members configured to sever tissue between the sealed tissue areas.

2. Discussion of Related Art

Electrosurgical and ultrasonic devices have become widely used by surgeons. Electrosurgery involves the application of thermal and/or electrical energy to cut, dissect, ablate, coagulate, cauterize, seal or otherwise treat biological tissue during a surgical procedure. Electrosurgery is typically performed using an electrosurgical generator operable to output energy and a handpiece including a surgical instrument (e.g., end effector) adapted to transmit energy to a tissue site during electrosurgical procedures. Electrosurgery can be performed using either a monopolar or a bipolar instrument.

The basic purpose of both monopolar and bipolar electrosurgery is to produce heat to achieve the desired tissue/clinical effect. In monopolar electrosurgery, devices use an instrument with a single, active electrode to deliver energy from an electrosurgical generator to tissue, and a patient return electrode or pad that is attached externally to the patient (e.g., a plate positioned on the patient's thigh or back) as the means to complete the electrical circuit between the electrosurgical generator and the patient. When the electrosurgical energy is applied, the energy travels from the active electrode, to the surgical site, through the patient and to the return electrode.

In bipolar electrosurgery, both the active electrode and return electrode functions are performed at the site of surgery. Bipolar electrosurgical devices include two electrodes that are located in proximity to one another for the application of current between their surfaces. Bipolar electrosurgical current travels from one electrode, through the intervening tissue to the other electrode to complete the electrical circuit. Bipolar instruments generally include end-effectors, such as grippers, cutters, forceps, dissectors and the like.

Forceps utilize mechanical action to constrict, grasp, dissect and/or clamp tissue. By utilizing an electrosurgical forceps, a surgeon can utilize both mechanical clamping action and electrosurgical energy to effect hemostasis by heating the tissue and blood vessels to cauterize, coagulate/desiccate, seal and/or divide tissue. Bipolar electrosurgical forceps utilize two generally opposing electrodes that are operably associated with the inner opposing surfaces of the end effectors and that are both electrically coupled to an electrosurgical generator. In bipolar forceps, the end-effector assembly generally includes opposing jaw assemblies pivotably mounted with respect to one another. In a bipolar configuration, only the tissue grasped between the jaw assemblies is included in the electrical circuit. Because the return function is performed by one jaw assembly of the forceps, no patient return electrode is needed.

By utilizing an electrosurgical forceps, a surgeon can cauterize, coagulate/desiccate and/or seal tissue and/or simply reduce or slow bleeding by controlling the intensity, frequency and duration of the electrosurgical energy applied through the jaw assemblies to the tissue. During the sealing process, mechanical factors such as the pressure applied between opposing jaw assemblies and the gap distance between the electrically-conductive tissue-contacting surfaces (electrodes) of the jaw assemblies play a role in determining the resulting thickness of the sealed tissue and effectiveness of the seal.

A variety of types of end-effector assemblies have been employed for various types of surgery, e.g., electrosurgery using a variety of types of monopolar and bipolar electrosurgical instruments.

SUMMARY

A continuing need exists for a reliable surgical instrument that assists in gripping, manipulating and holding tissue prior to and during activation and dividing of the tissue. A need exists for surgical instruments with an end-effector assembly suitable for use with a variety of energy sources.

According to an aspect of the present disclosure, a surgical device is provided. The surgical device includes an elongated shaft having an end-effector assembly at a distal end thereof. The end-effector assembly includes first, second and third jaw members. The first and second jaw members controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member disposed therebetween, to a second position closer to the third jaw member, wherein the first, second and third jaw members cooperate to grasp tissue therebetween. The surgical device also includes a knife operatively coupled to the elongated shaft. A channel defined along a length of an upper surface of the third jaw member is configured to slideably receive a portion of the knife therein.

According to another aspect of the present disclosure, an end-effector assembly operatively coupled to a shaft is provided. The end-effector assembly includes movable first, second and third jaw members. The first and second jaw members are pivotably mounted with respect to one another. The third jaw member is disposed between the first and second jaw members. The first and second jaw members are configured to be controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member, to a second position closer to the third jaw member, wherein the first, second and third jaw members cooperate to grasp tissue therebetween. A channel is defined along a length of an upper surface of the third jaw member and configured to slideably receive a portion of a knife therein.

According to another aspect of the present disclosure, an end-effector assembly operatively coupled to an elongated shaft is provided. The end-effector assembly includes movable first, second and third jaw members. The first and second jaw members are pivotably mounted with respect to one another. The third jaw member is disposed between the first and second jaw members. The first and second jaw members are configured to be controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member, to a second position, wherein the first, second and third jaw members cooperate to grasp tissue therebetween. A cutting member is disposed on an upper surface of the third jaw member.

BRIEF DESCRIPTION OF THE DRAWINGS

Objects and features of the presently-disclosed surgical instruments and end-effector assemblies including three jaw members for use in surgical instruments to grasp, seal, and/or cut tissue will become apparent to those of ordinary skill in the art when descriptions of various embodiments thereof are read with reference to the accompanying drawings, of which:

FIG. 1 is a right, side view of a surgical instrument showing a housing, a rotatable member, a shaft, and an end-effector assembly including three jaw members in accordance with an embodiment of the present disclosure;

FIG. 2A is an enlarged, perspective view of a portion of the shaft and the end-effector assembly of the surgical instrument of FIG. 1 showing the end-effector assembly disposed in an open configuration, wherein the first and second jaw members are spaced apart from the third jaw member disposed therebetween, in accordance with an embodiment of the present disclosure;

FIG. 2B is an enlarged, perspective view of the end-effector assembly of FIG. 2A showing the third jaw member disposed downwardly at a first angle, e.g., relative to a longitudinal axis defined by the shaft, in accordance with an embodiment of the present disclosure;

FIG. 3 is an enlarged, perspective view of the end-effector assembly of FIG. 1 disposed in the configuration shown in FIG. 2B, shown with tissue disposed below the lower surfaces of the first and second jaw members and tissue overlying the cutting member outwardly extending from the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 4 is an enlarged, perspective view of the end-effector assembly of FIG. 1 disposed in the configuration shown in FIG. 2A, shown with tissue disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, and tissue overlying the cutting member outwardly extending from the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 5 is an enlarged, perspective view of the end-effector assembly of FIG. 4 showing the first and second jaw members in a closed configuration with tissue in compression disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, shown with tissue in tension overlying the cutting member outwardly extending from the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 6 is an enlarged, end view of the end-effector assembly of FIG. 5 showing the first and second jaw members in a closed configuration with sealed tissue in compression disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, shown with tissue severed into two portions by the cutting member, in accordance with an embodiment of the present disclosure;

FIG. 7 is an enlarged, perspective view of a portion of a surgical instrument including an elongated shaft, a knife including a knife blade, and an end-effector assembly including first and second jaw members shown spaced apart from a third jaw member disposed therebetween, shown with the knife blade disposed within the distal end portion of the shaft, in accordance with an embodiment the present disclosure;

FIG. 8 is an enlarged, perspective view of the end-effector assembly of FIG. 7 showing the third jaw member disposed downwardly at a first angle, shown with tissue overlying the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 9 is an enlarged, perspective view of the end-effector assembly of FIG. 8 showing the first and second jaw members in a closed configuration with sealed tissue in compression disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, shown with the knife partially extended along a portion of the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 10 is an enlarged, perspective view of the end-effector assembly of FIG. 9 showing the knife blade positioned distal to tissue severed into two portions disposed above the sealed tissue in compression in accordance with an embodiment of the present disclosure;

FIG. 11 is an enlarged, perspective view of an elongated shaft, a knife cover defining an interior cavity, a knife including a knife blade disposed within the interior cavity, and an end-effector assembly including first and second jaw members shown spaced apart from a third jaw member disposed therebetween in accordance with an embodiment of the present disclosure;

FIG. 12 is an enlarged, perspective view of the end-effector assembly of FIG. 11, showing the first and second jaw members in a closed configuration with sealed tissue disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive surfaces of the first and second jaw members, respectively, and severed tissue disposed above the third jaw member, showing the knife blade positioned distal to tissue severed into two portions disposed above the sealed tissue in compression, in accordance with an embodiment of the present disclosure;

FIG. 13 is an enlarged, end view of a surgical instrument including an end-effector assembly including first and second jaw members shown in a closed configuration with a third jaw member disposed therebetween, showing a cutting member disposed on the upper surface the third jaw member and extending outwardly therefrom, in accordance with an embodiment of the present disclosure;

FIG. 14 is an enlarged, perspective view of the end-effector assembly of FIG. 13 showing the first and second jaw members spaced apart from the third jaw member disposed therebetween in accordance with an embodiment of the present disclosure;

FIG. 15 is an enlarged, perspective view of the end-effector assembly of FIG. 14 showing the third jaw member disposed downwardly at a first angle, shown with tissue overlying the cutting member, in accordance with an embodiment of the present disclosure;

FIG. 16 is an enlarged, perspective view of the end-effector assembly of FIG. 15 disposed in the configuration shown in FIG. 14 showing tissue disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, and tissue overlying the cutting member in accordance with an embodiment of the present disclosure;

FIG. 17 is an enlarged, perspective view of the end-effector assembly of FIG. 16 showing the first and second jaw members in a closed configuration with sealed tissue in compression disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, shown with partially-severed tissue in tension disposed above the third jaw member, in accordance with an embodiment of the present disclosure; and

FIG. 18 is an enlarged, perspective view of the end-effector assembly of FIG. 17 showing the third jaw member disposed upwardly at a second angle, shown with tissue severed into two portions disposed above the upper surface the third jaw member, in accordance with an embodiment of the present disclosure.

FIG. 19A is an enlarged, schematic view of an end-effector assembly disposed in an open configuration, wherein the first and second jaw members are spaced apart from one another and positioned above the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 19B is an enlarged, schematic view of the end-effector assembly of FIG. 19A showing the first, second and third jaw members in a closed configuration in accordance with an embodiment of the present disclosure;

FIG. 20 is an enlarged, perspective view of the end-effector assembly of FIG. 19A shown with tissue disposed below lower surfaces of the first and second jaw members and tissue overlying an upper surface of the third jaw member in accordance with an embodiment of the present disclosure;

FIG. 21 is an enlarged, perspective view of the end-effector assembly of FIG. 20 showing the first and second jaw members in a closed configuration with tissue in compression disposed between electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, shown with tissue in tension overlying the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure;

FIG. 22A is an enlarged, schematic view another embodiment of an end-effector assembly disposed in an open configuration, wherein the first and second jaw members are spaced apart from one another and positioned above the third jaw member, in accordance with the present disclosure;

FIG. 22B is an enlarged, schematic view of the end-effector assembly of FIG. 22A showing the first, second and third jaw members in a closed configuration in accordance with an embodiment of the present disclosure;

FIG. 23 is an enlarged, perspective view of the end-effector assembly of FIG. 22A shown with tissue disposed below the electrically-conductive tissue-engaging surfaces of the first and second jaw members and tissue overlying an upper surface of the third jaw member in accordance with an embodiment of the present disclosure; and

FIG. 24 is an enlarged, perspective view of the end-effector assembly of FIG. 23 showing the first and second jaw members in a closed configuration with tissue in compression disposed between the electrically-conductive tissue-engaging surfaces of the third jaw member and the electrically-conductive tissue-engaging surfaces of the first and second jaw members, respectively, shown with tissue in tension overlying the upper surface of the third jaw member, in accordance with an embodiment of the present disclosure.

DETAILED DESCRIPTION

Hereinafter, embodiments of surgical instruments and end-effector assemblies including three jaw members for use in surgical instruments to grasp, seal, and/or cut tissue of the present disclosure are described with reference to the accompanying drawings. Like reference numerals may refer to similar or identical elements throughout the description of the figures. As shown in the drawings and as used in this description, and as is traditional when referring to relative positioning on an object, the term “proximal” refers to that portion of the apparatus, or component thereof, closer to the user and the term “distal” refers to that portion of the apparatus, or component thereof, farther from the user.

This description may use the phrases “in an embodiment,” “in embodiments,” “in some embodiments,” or “in other embodiments,” which may each refer to one or more of the same or different embodiments in accordance with the present disclosure.

Various embodiments of the present disclosure provide surgical instruments suitable for sealing, cauterizing, coagulating/desiccating, and/or cutting vessels and vascular tissue. Embodiments of the presently-disclosed surgical instruments with an end-effector assembly including three jaw members may be suitable for utilization in endoscopic surgical procedures and/or suitable for utilization in open surgical applications. Embodiments of the presently-disclosed surgical instruments may be implemented using a variety of types of energy, e.g., electrosurgical energy at radio frequencies (RF) and/or at other frequencies, ultrasonic, optical, and/or thermal energy. Embodiments of the presently-disclosed surgical instruments may be configured to be connectable to one or more energy sources, e.g., RF generators and/or ultrasonic generators.

The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the surgeon in the operating theater and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include, remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knives, scissors, etc.) which may complement the use of one or more of the embodiments described herein. In various embodiments disclosed herein, an end-effector assembly including three jaw members may be coupled to a pair of master handles by a controller. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the three jaw members onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon's ability to mimic actual operating conditions.

In FIG. 1, an embodiment of a surgical instrument 10 is shown for use with various surgical procedures, e.g., endoscopic surgical procedures. Surgical instrument 10 generally includes a housing 60, a handle assembly 30, a rotatable assembly 80, a trigger assembly 70, and an end-effector assembly 91 that mutually cooperate to grasp, seal and/or divide tissue (e.g., tissue “T” shown in FIG. 3), e.g., tubular vessels and vascular tissue. End-effector assembly 91 includes a first jaw member 110, a second jaw member 120, and a third jaw member 130 disposed between the first and second jaw members 110 and 120, respectively, which are configured to be controllably movable, e.g., to grasp and/or seal tissue.

The first and second jaw members 110 and 120 are configured to be controllably movable relative to one another and/or relative to the third jaw member 130, e.g., to control the amount of compression applied to tissue (e.g., tissue in compression “T_(C)” shown in FIGS. 5 and 6). In some embodiments, the instrument 10 is configured to provide a user capability to controllably move the first and second jaw members 110 and 120 laterally towards the third jaw member 130 to progressively tension tissue (e.g., tissue in tension “T_(T)” shown in FIGS. 5 and 6) overlying the upper surface 134 of the third jaw member 130.

In some embodiments, as shown in FIGS. 1 through 6, third jaw member 130 includes a cutting member 156 disposed along a portion of the upper surface 134 of the third jaw member 130. As best seen in FIGS. 3 through 6, the cutting member 156 includes a cutting edge 158. End-effector assembly 91 may be configured to allow the cutting member 156 or portion thereof, e.g., the cutting edge 158, to be selectively retractable and extendable through an opening (not shown) defined in the upper surface 134 of the third jaw member 130.

Surgical instrument 10 generally includes an elongated shaft 12 defining a longitudinal axis “A-A”. Shaft 12 supports movement of other components therethrough, e.g., to impart movement to the first, second and third jaw members 110, 120 and 130, respectively. In some embodiments, the trigger assembly 70 is operatively coupled to the end-effector assembly 91, e.g., to allow the surgeon to change the position and/or orientation of the third jaw member 130.

Although FIG. 1 depicts a surgical instrument 10 for use in connection with endoscopic surgical procedures, the teachings of the present disclosure may also apply to more traditional open surgical procedures. For the purposes herein, the device 10 is described in terms of an endoscopic instrument; however, an open version of the device may also include the same or similar operating components and features as described below.

In some embodiments, as shown in FIG. 1, first jaw member 110 and the second jaw member 120 are pivotably connected about a pivot pin 103 and controllably movable relative to one another and/or relative to the third jaw member 130, e.g., pivotably movable about the pivot pin 103, in a curvilinear direction “D₁” as shown in FIG. 2A. First jaw member 110, the second jaw member 120, and/or the third jaw member 130 may be curved at various angles to facilitate manipulation of tissue and/or to provide enhanced line-of-sight for accessing targeted tissues. The first, second, and third jaw members 110, 120, and 130, respectively, may be formed from any suitable material or combination of materials by any suitable process, e.g., machining, stamping, electrical discharge machining (EDM), forging, casting, injection molding, metal injection molding (MIM), and/or fineblanking. End-effector assembly 91 may include one or more electrically-insulative elements to electrically isolate the first jaw member 110 from the second jaw member 120. End-effector assembly 91 may additionally, or alternatively, include one or more electrically-insulative bushings to electrically isolate the third jaw member 130 from the first jaw member 110 and/or the second jaw member 120.

End-effector assembly 91 may include one or more electrically-conductive tissue-engaging surfaces (also referred to herein as “sealing plates”) coupled to, or otherwise disposed in association with, the first, second and/or third jaw member 110, 120 and/or 130, respectively. In some embodiments, as shown in FIGS. 2A through 6, end-effector assembly 91 includes first and second electrically-conductive tissue-engaging surfaces 112 and 122, respectively, wherein the first electrically-conductive tissue-engaging surface 112 is coupled to, or otherwise disposed in association with, the first jaw member 110, and the second electrically-conductive tissue-engaging surface 122 is coupled to, or otherwise disposed in association with, the second jaw member 120. End-effector assembly 91 may include electrically-insulative members configured to electrically isolate, at least in part, the first and second electrically-conductive tissue-engaging surfaces 112 and 122 (also referred to herein as “first and second sealing plates 112 and 122”) from the first and second jaw members 110 and 120, respectively. In some embodiments, the first and second sealing plates 112 and 122 may be integrally formed with the first and second jaw members 110 and 120, respectively. End-effector assembly 91 may additionally, or alternatively, include electrically-conductive tissue-engaging surfaces coupled to, or otherwise disposed in association with, the third jaw member 130.

In some embodiments, as shown in FIGS. 2A through 6, the end-effector assembly 91 additionally includes third and fourth sealing plates 131 and 132 coupled to, or otherwise disposed in association with, the third jaw member 130, wherein the first and third sealing plates 112 and 131, respectively, are disposed in opposing relation to one another, and the second and fourth sealing plates 122 and 132, respectively, are disposed in opposing relation to one another. In some embodiments, the end-effector assembly 91 may be configured to allow the first, second, third and fourth sealing plates 112, 122, 131 and 132 to be separately activated, and/or activated in pairs (e.g., first and third sealing plates 112 and 131 and/or second and fourth sealing plates 122 and 132).

As shown in FIG. 1, the shaft 12 includes a distal end 16 configured to mechanically engage the end-effector assembly 91. In some embodiments, the end-effector assembly 91 is selectively and releaseably engageable with the distal end 16 of the shaft 12. In some embodiments, as shown FIGS. 2A and 2B, shaft 12 includes an outer shaft member 160 and an inner shaft member 180 that is configured for longitudinal motion with respect to the outer shaft member 160. Inner shaft member 180 is slidingly disposed within the outer shaft member 160 and operable by a drive assembly (not shown). The proximal end 14 of the shaft 12 is received within the housing 60 and examples of connections relating thereto, and examples of drive assembly embodiments of the surgical instrument 10, are described in commonly assigned U.S. Pat. No. 7,150,097 entitled “METHOD OF MANUFACTURING JAW ASSEMBLY FOR VESSEL SEALER AND DIVIDER,” commonly assigned U.S. Pat. No. 7,156,846 entitled “VESSEL SEALER AND DIVIDER FOR USE WITH SMALL TROCARS AND CANNULAS,” commonly assigned U.S. Pat. No. 7,597,693 entitled “VESSEL SEALER AND DIVIDER FOR USE WITH SMALL TROCARS AND CANNULAS,” and commonly assigned U.S. Pat. No. 7,771,425 entitled “VESSEL SEALER AND DIVIDER HAVING A VARIABLE JAW CLAMPING MECHANISM.”

Surgical instrument 10 includes a cable 310. Cable 310 may be formed from a suitable flexible, semi-rigid or rigid cable, and may connect directly to an energy source 28, e.g., an ultrasonic and/or electrosurgical power generating source. In some embodiments, the cable 310 connects the surgical instrument 10 to a connector 17, which further operably connects the instrument 10 to the energy source 28. Cable 310 may be internally divided into one or more cable leads (not shown) each of which transmits energy through its respective feed path to the end-effector assembly 91. In some embodiments, cable 310 may include optical fiber.

Energy source 28 may be any generator suitable for use with surgical devices, and may be configured to provide various frequencies of electrosurgical energy, optical energy, and/or ultrasound. Examples of electrosurgical generators that may be suitable for use as a source of electrosurgical energy are commercially available under the trademarks FORCE EZ™, FORCE FX™, and FORCE TRIAD™ offered by Covidien Surgical Solutions of Boulder, CO. Surgical instrument 10 may alternatively be configured as a wireless device or battery-powered.

As shown in FIG. 1, the end-effector assembly 91 is rotatable about a longitudinal axis “A-A” through rotation, either manually or otherwise, of the rotatable assembly 80. Rotatable assembly 80 generally includes two halves (not shown), which, when assembled about the shaft 12, form a generally circular rotatable member 82. Rotatable assembly 80, or portions thereof, may be configured to house a drive assembly (not shown) or components thereof. Examples of rotatable assembly embodiments and drive assembly embodiments of the surgical instrument 10 are described in the above-mentioned, commonly-assigned U.S. Pat. Nos. 7,150,097, 7,156,846, 7,597,693 and 7,771,425.

Handle assembly 30 includes a fixed handle 50 and a movable handle 40. In some embodiments, the fixed handle 50 is integrally associated with the housing 60, and the movable handle 40 is selectively movable relative to the fixed handle 50. Movable handle 40 of the handle assembly 30 is ultimately connected to the drive assembly (not shown). As can be appreciated, applying force to move the movable handle 40 toward the fixed handle 50 pulls a drive element (e.g., inner shaft member 180) proximally to impart movement to the first and second jaw members 110 and 120 from an open position, wherein the first and second jaw members 110 and 120 are disposed in spaced relation relative to the third jaw member 130, to a clamping or closed position, wherein the first, second and third jaw members 110, 120 and 130 cooperate to grasp tissue therebetween. Examples of handle assembly embodiments of the surgical instrument 10 are described in the above-mentioned, commonly-assigned U.S. Pat. Nos. 7,150,097, 7,156,846, 7,597,693 and 7,771,425.

Surgical instrument 10 includes a switch 200 configured to permit the user to selectively activate the instrument 10 in a variety of different orientations, i.e., multi-oriented activation. As can be appreciated, this simplifies activation. When the switch 200 is depressed, energy is transferred through one or more pathways, e.g., electrical leads (not shown) and/or optical fiber (not shown), to the first and second jaw members 110 and 120. Additionally, or alternatively, when switch 200 is depressed, energy may be transferred through one or more electrical leads (not shown) to the third jaw member 130. Although FIG. 1 depicts the switch 200 disposed at the proximal end of the housing assembly 60, switch 200 may be disposed on another part of the instrument 10 (e.g., the fixed handle 50, rotatable member 82, etc.) or another location on the housing assembly 60.

FIG. 2A shows the end-effector assembly 91 in an open configuration wherein the first and second jaw members 110 and 120 are disposed in spaced relation relative to the third jaw member 130 disposed therebetween. First and second jaw members 110 and 120 are controllably movable with respect to one another and/or with respect to the third jaw member 130, e.g., along a curvilinear direction “D₁”, from an open configuration wherein the first and second jaw members 110 and 120 are disposed in spaced relation relative to the third jaw member 130, to a clamping or closed position, wherein the first, second and third jaw members 110, 120 and 130 cooperate to grasp tissue therebetween, e.g., to control the amount of compression applied to tissue (e.g., tissue in compression “T_(C)” shown in FIGS. 5 and 6). When the end-effector assembly 91 is disposed in an open configuration, the first and second side surfaces 131 and 132 of the third jaw member 130 are spaced apart from the first and second electrically-conductive tissue-engaging surfaces 112 and 122, respectively.

In FIG. 2B, the third jaw member 130 is shown disposed downwardly at a first angle, e.g., relative to the longitudinal axis “A-A” defined by the shaft 12 and/or relative to a plane defined by the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively. In some embodiments, the first angle may be an acute angle, e.g., an angle that measures between 0 degrees and 90 degrees. When the third jaw member is slanted downward, the distal end 137 of the third jaw member 130 is positioned offset from the longitudinal axis “A-A” defined by the shaft 12, e.g., to provide the surgeon with the capability to position tissue (e.g., tissue “T” shown in FIG. 3) over the upper surface 134 of the third jaw member 130.

FIG. 3 shows the end-effector assembly 91, wherein the third jaw member 130 is disposed slanted downward at a first angle with tissue “T”, e.g., tubular vessel, in contact with the first, second, and third jaw members 110, 120, and 130. End-effector assembly 91 is configured to allow the surgeon to position the first, second and third jaw members 110, 120 and 130, respectively, in relation to tissue “T”, e.g., wherein portions of tissue “T” are disposed below the lower surfaces 113 and 123 of the first and second jaw members 110 and 120 and a portion of tissue “T is disposed above the upper surface 134 of the third jaw member 130.

FIG. 4 shows the end-effector assembly 91 disposed in an open configuration wherein the first and second jaw members 110 and 120 are spaced apart from the third jaw member 130 disposed therebetween. End-effector assembly 91 is configured to allow the surgeon to position the first, second, and third jaw members 110, 120, and 130, respectively, into vertical alignment relative to one another, wherein the upper surfaces 114 and 124 of the first and second jaw members 110 and 120 are substantially coplanar with the upper surface 134 of the third jaw member 130, e.g., as shown in FIGS. 2A and 4. In FIG. 4, the first and second electrically-conductive tissue-engaging surfaces 131 and 132 of the third jaw member 130 and the first and second electrically-conductive tissue-engaging surfaces 112 and 122, respectively, are shown with tissue “T” disposed therebetween, and with tissue “T” overlying the cutting edge 158 of the cutting member 156 extending from the upper surface 134 of the third jaw member 130.

FIG. 5 shows the end-effector assembly 91 with the first, second and third jaw members 110, 120 and 130 in a closed configuration, e.g., after tissue sealing, wherein sealed tissue in compression “T_(C)” is disposed between the first and, third sealing plates 112 and 131 of the first and third jaw members 110 and 130, respectively, and the second and fourth sealing plates 122 and 132 of the second and third jaw members 120 and 130, respectively, with tissue in tension “T_(T)” overlying the cutting edge 158 of the cutting member 156.

In FIG. 6, the end-effector assembly 91 is shown with the first, second and third jaw members 110, 120 and 130 in a closed configuration, with tissue in compression “T_(C)” disposed between the first and, third sealing plates 112 and 131 of the first and third jaw members 110 and 130, respectively, and the second and fourth sealing plates 122 and 132 of the second and third jaw members 120 and 130, respectively, and with severed tissue “T_(S)” disposed above the third jaw member 130, e.g., tissue “T” has been severed into two portions “T_(S)” by the cutting edge 158.

In some embodiments, the third jaw member 130 includes a channel defined in the upper surface 134 thereof, wherein the channel is disposed in communication with an interior cavity defined within the third jaw member 130 configured to receive the cutting member 156 therein. Third jaw member 130 may be configured with a mechanism to allow for selective raising and lowering of the cutting member 156, e.g., from a first configuration wherein the cutting member 156 is disposed within the interior cavity to a second configuration wherein at least the cutting edge 158 of the cutting member 156 is disposed above the upper surface 134 of the third jaw member 130.

FIGS. 7 through 10 show a portion of an elongated shaft 712 of a surgical instrument, a knife 156 operatively coupled to the shaft 712, and an end-effector assembly 791 disposed at the distal end the shaft 712 in accordance with an embodiment of the present disclosure. Knife 756 includes a knife bar 757 and a knife blade 758 disposed at the distal end of the knife bar 757. End-effector assembly 791 includes the first and second jaw members 110 and 120 and the first and second sealing plates 112 and 122 of the end-effector assembly 91 shown in FIGS. 1 through 6, and further description of those features is omitted in the interests of brevity.

End-effector assembly 791 includes a controllably movable third jaw member 730 disposed between the first and second jaw members 110 and 120. In some embodiments, the third jaw member 730 is controllably movable from a first configuration, wherein an upper surface 734 of the third jaw member 730 is substantially coplanar with the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively, to a second configuration, wherein the upper surface 734 of the third jaw member 730 is disposed below (or above) a plane defined by the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively. In some embodiments, as shown in FIGS. 7 through 10, end-effector assembly 791 includes third and fourth sealing plates 731 and 732, respectively, coupled to, or otherwise disposed in association with, the third jaw member 730.

In FIG. 7, the end-effector assembly 791 is shown disposed in an open configuration wherein the first and second jaw members 110 and 120 are spaced apart from the third jaw member 730 disposed therebetween. A channel 751 defined along the length of the upper surface 734, or portion thereof, of the third jaw member 730 is configured to slideably receive a portion of the knife 756, e.g., a portion including the bottom edge of the knife bar 757. Channel 751 may have any suitable dimensions, e.g., length, width, and depth.

Shaft 712 generally includes a longitudinally-extending interior passageway having one or more lumens, channels, etc. defined therethrough. In some embodiments, as shown in FIGS. 7 through 10, shaft 712 includes a longitudinally-extending channel 713 defined therethrough. The knife bar 757 is configured to be slideably translatable through the channel 713 to allow for selective advancement of the knife blade 758. In some embodiments, the end-effector assembly 791 may be configured to prevent axial translation of the knife bar 757 when the upper surface 734 of the third jaw member 730 is disposed below a plane defined by the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively.

FIG. 8 shows the end-effector assembly 791 disposed in an open configuration wherein the third jaw member 730 is disposed slanted downward at a first angle, e.g., relative to a longitudinal axis defined by the shaft 712 and/or relative to a plane defined by the uppers surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively. In FIG. 8, the end-effector assembly 791 is positioned such that portions of tissue “T”, e.g., tubular vessel, are disposed below the lower surfaces 113 and 123 of the first and second jaw members 110 and 120, respectively, and a portion of tissue “T” is disposed above the upper surface 734 of the third jaw member 730.

In FIG. 9, the end-effector assembly 791 is shown with the first and second jaw members 110 and 120 in a closed configuration, e.g., after tissue sealing, with portions of sealed tissue in compression “T_(C)” disposed between the first and third sealing plates 112 and 731 of the first and third jaw members 110 and 730, respectively, and the second and fourth sealing plates 122 and 732 of the second and third jaw members 120 and 730, respectively, and tissue in tension “T_(T)” disposed overlying the upper surface 734 of the third jaw member 730. FIG. 9 shows the knife 756 in a partially extended configuration, wherein a portion the knife bar 757 is disposed within the channel 751 on the upper surface 734 of the third jaw member 730 and the knife blade 758 is positioned proximal to the tissue in tension “T_(T)” disposed overlying the upper surface 734.

FIG. 10 shows tissue in compression “T_(C)” between the first and third sealing plates 112 and 731 of the first and third jaw members 110 and 730, respectively, and the second and fourth sealing plates 122 and 732 of the second and third jaw members 120 and 730, respectively, of the end-effector 791, shown with severed tissue “T_(S)” disposed above the third jaw member 730. In FIG. 10, the knife blade 758 is disposed in an extended configuration and positioned distal to the severed tissue “T_(S)” and the tissue in compression “T_(C)”. The surgeon may maintain the end-effector assembly 791 in the closed configuration after tissue sealing and cutting, e.g., to view the severed tissue “T_(S)” to evaluate the integrity of the sealed tissue in compression “T_(C)”.

FIGS. 11 and 12 show a portion of an elongated shaft 1112 of a surgical instrument, a knife 1156 operatively coupled to the shaft 1112, a knife cover 1117 protruding outwardly of the outer circumferential surface of the shaft 1112, and an end-effector assembly 1191 disposed at the distal end the shaft 1112. A knife cavity 1116 defined by the knife cover 1117 may be configured to receive the entire knife 1156 therein. Alternatively, the knife cavity 1116 may be configured to receive a portion, e.g., an upper portion, of the knife 1156 therein.

End-effector assembly 1191 includes the first and second jaw members 110 and 120 and the first and second sealing plates 112 and 122 of the end-effector assembly 91 shown in FIGS. 1 through 6, and further description of those features is omitted in the interests of brevity. End-effector assembly 1191 includes a controllably movable third jaw member 1130 disposed between the first and second jaw members 110 and 120.

Third jaw member 1130 is controllably movable from a first configuration, wherein the first, second and third jaw members 110, 120 and 1130 are disposed in vertical alignment relative to one another (e.g., an upper surface 1134 of the third jaw member 130 is substantially coplanar with the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively), to a second configuration, wherein the upper surface 1134 of the third jaw member 1130 is disposed at an angle, e.g., relative to a plane defined by the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively. In some embodiments, as shown in FIGS. 11 and 12, the end-effector assembly 1191 includes third and fourth sealing plates 1131 and 1132, respectively, coupled to, or otherwise disposed in association with, the third jaw member 1130.

In FIG. 11, the end-effector assembly 1191 is shown in an open configuration wherein the first and second jaw members 110 and 120 are spaced apart from the third jaw member 1130 disposed therebetween. A channel 1751 defined along the length of the upper surface 1134 of the third jaw member 1130 is configured to slideably receive a bottom portion of the knife 1156. Channel 1751 may have any suitable dimensions, e.g., length, width, and depth. An opening 1114 at the distal end 1115 of the knife cover 1117 is disposed in communication with the knife cavity 1116 and configured to allow axial translation of the knife 1156. In some embodiments, the end-effector assembly 1191 may be configured to prevent axial translation of the knife 1156 when the upper surface 1134 of the third jaw member 1130 is disposed below a plane defined by the upper surfaces 114 and 124 of the first and second jaw members 110 and 120, respectively.

Knife 1156 includes a knife bar 1157 and a knife blade 1158 disposed at the distal end of the knife bar 1157. Knife 1156 may be operatively coupled to a drive assembly (not shown) and/or a trigger assembly (not shown). The drive assembly may have any suitable configuration to allow axial reciprocation of the knife 1156, e.g., to cause movement of the knife blade 1158 from a retracted position within the knife cavity 1116 to an extended position outside the knife cavity 1116. In some embodiments, a trigger assembly (not shown) is operatively disposed relative to a handle for selectively advancing the knife 1156 for cutting tissue along the upper surface 1134 of the third jaw member 1130.

As shown in FIG. 12, the movement of the knife blade 1158 to an extended position effects the cutting of tissue in tension “T_(T)” disposed over the upper surface 1134 of the third jaw member 1130. In some embodiments, the knife 1156 is prevented from movement, e.g., in a distal direction, when the third jaw member 1130 is disposed in an angled/slanted (downward or upward) configuration. FIG. 12 shows sealed tissue in compression “T_(C)” between the first and third sealing plates 112 and 1131 of the first and third jaw members 110 and 1130, respectively, and the second and fourth sealing plates 122 and 1132 of the second and third jaw members 120 and 1130, respectively, wherein severed tissue “T_(S)” is disposed above the third jaw member 1130, with the knife blade 1158 positioned distal to the severed tissue “T_(S)”.

FIGS. 13 through 18 show a portion of a surgical instrument including an end-effector assembly 1391. End-effector assembly 1391 includes the first and second jaw members 110 and 120 and the first and second sealing plates 112 and 122 of the end-effector assembly 91 shown in FIGS. 1 through 6, and further description of those features is omitted in the interests of brevity. End-effector assembly 1391 includes a controllably movable third jaw member 1330 disposed between the first and second jaw members 110 and 120. In some embodiments, as shown in FIGS. 13 through 17, the end-effector assembly 1391 includes third and fourth sealing plates 1331 and 1332, respectively, coupled to, or otherwise disposed in association with, the third jaw member 1330.

In FIG. 13, the end-effector assembly 1391 is shown with the first and second jaw members 110 and 120 in a closed configuration with a third jaw member 1330 disposed therebetween. End-effector assembly 1391 includes the cutting member 1356 disposed on the upper surface 1334 of the third jaw member 1330 and extending outwardly therefrom. End-effector assembly 1391 may include additional, fewer, or different components than shown in FIGS. 13 through 18, depending upon a particular purpose or to achieve a desired result. The shape and size of the first, second and third jaw members 110, 120 and 1330, respectively, may be varied from the configuration depicted in FIGS. 13 through 18.

In some embodiments, the cutting member 1356 is an ultrasonic member configured to treat tissue, e.g., to transect, dissect and/or coagulate tissue. The ultrasonic member may be operably coupled to an ultrasonic transducer (not shown), which may be supported within the housing of the surgical instrument and operably coupled to ultrasonic signal generator.

In some embodiments, the cutting member 1356 may have a monopolar cutting edge (not shown) configured to treat tissue, e.g., to transect, dissect and/or coagulate tissue. In such cases, the end-effector assembly 1391 may be variously configured to provide suitable electrical isolation between the monopolar cutting edge and the jaw third jaw member 1330.

In FIG. 14, the end-effector assembly 1391 is shown in a configuration wherein the first and second jaw members 110 and 120 are disposed in spaced relation relative to the third jaw member 1330 disposed therebetween. As shown in FIG. 14, the first jaw member 110 includes an upper surface 114 and a bottom surface 113, the second jaw member 120 includes an upper surface 124 and a bottom surface 123, and the third jaw member 1330 includes an upper surface 1334 and a bottom surface 1333.

In FIG. 15, the first and second jaw members 110 and 120 are disposed in spaced relation relative to the third jaw member 1330 as shown in FIG. 14, and the third jaw member 1330 is oriented at a downward angle, e.g., relative to the longitudinal axis “A-A” (FIG. 1) defined by the shaft. In the configuration shown in FIG. 15, the bottom surface of the third jaw member 1330 is positioned below a plane defined by the bottom surfaces 113 and 123 of the first and second jaw members 110 and 120, respectively. Tissue “T” is depicted overlying a portion of the cutting member 1356 disposed on the upper surface 1334 of the third jaw member 1330.

In FIG. 16, the first and second jaw members 110 and 120 are shown disposed in spaced relation relative to the third jaw member 1330, with portions of tissue “T” disposed between the first and third sealing plates 112 and 1331 of the first and third jaw members 110 and 1330, respectively, and the second and fourth sealing plates 122 and 1332 of the second and third jaw members 120 and 1330, respectively, and tissue in tension “T_(T)” overlying a portion of the cutting member 1356 disposed on the upper surface 1334 of the third jaw member 1330.

FIG. 17 shows the first and second jaw members 110 and 120 in a closed configuration with tissue in compression “T_(C)”, e.g., vascular tissue, between the first and second electrically-conductive tissue-engaging surfaces 112 and 122, shown with tissue in tension “T_(T)” overlying the cutting member 1356 disposed on the upper surface 1334 of the third jaw member 1330. During a procedure, when the first and second jaw members 110 and 120 are disposed in a closed configuration, e.g., to effectively grasp tissue “T”, energy is applied via the first, second, third and fourth electrically-conductive tissue-engaging surfaces 112, 122, 1331 and 1332 to effect sealing of the tissue in compression “T_(C)”. Once the tissue in compression “T_(C)” is sealed, the cutting member 1356 may be used to transect, dissect and/or coagulate the tissue in tension “T_(T)” overlying the upper surface 1334 of the third jaw member 1330. In FIG. 17, partially-cut tissue in tension “T_(T)” is illustratively depicted. In some embodiments, as shown in FIG. 18, the end-effector assembly 1391 is configured to allow the user to selectively apply tension, e.g., upward tension, to the tissue in tension “T_(T)” during treatment by the cutting member 1356. In embodiments wherein the cutting member 1356 is an ultrasonic member, during a procedure, upward tension applied to the tissue in tension “T_(T)” may improve efficiency, e.g., increase the rate of dissection and/or coagulation, and/or otherwise improve the outcome.

In an embodiment shown in FIG. 18, the end-effector assembly 1391 is configured to allow the user to effect movement of the third jaw member 1330, which changes the orientation of the cutting member 1356 disposed on the upper surface 1334 of the third jaw member 1330, e.g., to selectively apply tension to the tissue in tension “T_(T)” during treatment by the cutting member 1356. In FIG. 18, the end-effector assembly 1391 is shown with tissue in compression “T_(C)” between the first and third sealing plates 112 and 1331 of the first and third jaw members 110 and 1330, respectively, and the second and fourth sealing plates 122 and 1332 of the second and third jaw members 120 and 1330, respectively, and severed tissue “T_(S)” disposed above the upper surface 1334 of the third jaw member 1330.

FIGS. 19A through 21 show an end-effector assembly 1991 that includes a first jaw member 1910, a second jaw member 1920, and a third jaw member 1930. The first and second jaw members 1910 and 1920 are configured to be controllably movable relative to one another and/or relative to the third jaw member 1930, e.g., to control the amount of compression applied to tissue (e.g., tissue in compression “T_(C)” shown in FIG. 21).

As illustrated in FIGS. 19A and 19B, the first and second jaw members 1910 and 1920 are configured to be controllably movable along a curvilinear direction “D₃”, from an open configuration wherein the lower surfaces 1913 and 1923 of the first and second jaw members 1910 and 1920, respectively, are disposed in spaced relation relative to the third jaw member 1930 (FIGS. 19A and 20), to a clamping or closed position (FIG. 19B), wherein the first, second and third jaw members 1910, 1920 and 1930 cooperate to grasp tissue “T” therebetween.

In some embodiments, as shown in FIG. 20, end-effector assembly 1991 includes first and second electrically-conductive tissue-engaging surfaces 1912 and 1922, respectively, wherein the first electrically-conductive tissue-engaging surface 1912 (also referred to herein as “first sealing plate 1912”) is coupled to, or otherwise disposed in association with, the first jaw member 1910, and the second electrically-conductive tissue-engaging surface 1922 (also referred to herein as “second sealing plate 1922”) is coupled to, or otherwise disposed in association with, the second jaw member 1920. End-effector assembly 1991 may additionally, or alternatively, include third and fourth electrically-conductive tissue-engaging surfaces 1931 and 1932 (also referred to herein as “third and fourth sealing plates 1931 and 1932”) coupled to, or otherwise disposed in association with, the third jaw member 1930. End-effector assembly 1991 may include any feature or combination of features of the end-effector assembly embodiments described above.

FIG. 21 shows the end-effector assembly 1991 in a closed configuration with tissue in compression “T_(C)”, e.g., vascular tissue, disposed between the first and third sealing plates 1912 and 1931 of the first and third jaw members 1910 and 1930, respectively, and the second and fourth sealing plates 1922 and 1932 of the second and third jaw members 1920 and 1930, respectively, and with tissue in tension “T_(T)” overlying the upper surface 1934 of the third jaw member 1930.

FIGS. 22A through 24 show an end-effector assembly 2291 that includes a first jaw member 2210, a second jaw member 2220, and a third jaw member 2230. As shown in FIGS. 22A and 23, end-effector assembly 2291 includes a first electrically-conductive tissue-engaging surface 2212 coupled to, or otherwise disposed in association with, the first jaw member 2210, and a second electrically-conductive tissue-engaging surface 2222 coupled to, or otherwise disposed in association with, the second jaw member 2220. End-effector assembly 2291 may additionally, or alternatively, include third and fourth electrically-conductive tissue-engaging surfaces 2231 and 2232 coupled to, or otherwise disposed in association with, the third jaw member 2230. End-effector assembly 2291 may include any feature or combination of features of the end-effector assembly embodiments described above. The first and second jaw members 2210 and 2220 are configured to be controllably movable relative to one another and/or relative to the third jaw member 2230, e.g., along a curvilinear direction “D₄”, from an open configuration wherein the first and second electrically-conductive tissue-engaging surfaces 2212 and 2222 of the first and second jaw members 2210 and 2220, respectively, are disposed in spaced relation relative to the third jaw member 2230 (FIGS. 22A and 23), to a clamping or closed position (FIG. 22B), wherein the first, second and third jaw members 2210, 2220 and 2230 cooperate to grasp tissue “T” therebetween.

FIG. 24 shows the first and second jaw members 2210 and 2220 in a closed configuration with tissue in compression “T_(C)”, e.g., vascular tissue, therebetween, and with tissue in tension “T_(T)” overlying the upper surface of the third jaw member 2230. End-effector assembly 2291 may include any feature or combination of features of the end-effector assembly embodiments described above.

The above-described surgical instruments with an end-effector assembly including three jaw members are configured to allow the surgeon to move first and second jaw members from an open position, wherein the first and second jaw members are disposed in spaced relation relative to a third jaw member disposed therebetween, to a clamping or closed position, wherein the first, second and third jaw members, cooperate to grasp tissue therebetween. The above-described end-effector assemblies are configured to allow the first and second jaw members to be controllably movable relative to one another and/or relative to the third jaw member, e.g., to control the amount of compression applied to tissue. The above-described surgical instruments are configured to provide a user capability to controllably move the first and second jaw members laterally towards the third jaw member to progressively tension the tissue overlying the upper surface of the third jaw member.

The above-described surgical instruments with an end-effector assembly including three jaw members are configured to allow the third jaw member to be controllably movable from a first configuration, wherein an upper surface of the third jaw member is substantially coplanar with the upper surfaces of the first and second jaw members, to a second configuration, wherein the upper surface of the third jaw member is disposed below (or above) a plane defined by the upper surfaces of the first and second jaw members.

The above-described surgical instruments with an end-effector assembly including three jaw members may be suitable for sealing, cauterizing, coagulating/desiccating and/or cutting vessels and vascular tissue. The above-described surgical instruments with an end-effector assembly including three jaw members may be suitable for utilization in endoscopic surgical procedures and/or suitable for utilization in open surgical applications. The above-described surgical instruments with an end-effector assembly including three jaw members may be configured for use with a variety of energy sources.

Although embodiments have been described in detail with reference to the accompanying drawings for the purpose of illustration and description, it is to be understood that the inventive processes and apparatus are not to be construed as limited thereby. It will be apparent to those of ordinary skill in the art that various modifications to the foregoing embodiments may be made without departing from the scope of the disclosure. 

What is claimed is:
 1. A surgical device, comprising: an elongated shaft having an end-effector assembly at a distal end thereof, the end-effector assembly including first, second and third jaw members, the first and second jaw members controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member disposed therebetween, to a second position, wherein the first, second and third jaw members cooperate to grasp tissue therebetween; and a knife operatively coupled to the elongated shaft, wherein a channel defined along a length of an upper surface of the third jaw member is configured to slideably receive a portion of the knife therein.
 2. The surgical device of claim 1, wherein the third jaw member is configured to be controllably movable from a first configuration, wherein the upper surface of the third jaw member is substantially coplanar with upper surfaces of the first and second jaw members, to a second configuration, wherein the upper surface of the third jaw member is disposed below a plane defined by the upper surfaces of the first and second jaw members.
 3. The surgical device of claim 1, wherein the first and second jaw members are configured to be controllably movable towards the third jaw member to progressively tension tissue overlying the upper surface of the third jaw member.
 4. The surgical device of claim 1, further comprising first and second electrically-conductive tissue-engaging surfaces coupled to the first and second jaw members, respectively.
 5. The surgical device of claim 4, wherein the first and second electrically-conductive tissue-engaging surfaces are adapted to connect to an energy source.
 6. The surgical device of claim 1, wherein the knife includes a knife bar and a blade disposed at a distal end of the knife bar.
 7. The surgical device of claim 6, wherein the channel is configured to slideably receive a portion of the knife bar including a bottom edge thereof.
 8. An end-effector assembly, comprising: first and second jaw members pivotably mounted with respect to one another and a third jaw member disposed between the first and second jaw members, the first and second jaw members configured to be controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member, to a second position, wherein the first, second and third jaw members cooperate to grasp tissue therebetween; and a channel defined along a length of an upper surface of the third jaw member configured to slideably receive a portion of a knife therein.
 9. The end-effector assembly of claim 8, wherein the knife is selectively movable to cut tissue disposed between the first and second jaw members.
 10. The end-effector assembly of claim 8, wherein the third jaw member is configured to be controllably movable from a first configuration, wherein the upper surface of the third jaw member is substantially coplanar with upper surfaces of the first and second jaw members, to a second configuration, wherein the upper surface of the third jaw member is disposed below a plane defined by the upper surfaces of the first and second jaw members.
 11. The end-effector assembly of claim 8, wherein the first and second jaw members are configured to be controllably movable towards the third jaw member to progressively tension tissue overlying the upper surface of the third jaw member.
 12. An end-effector assembly, comprising: first and second jaw members pivotably mounted with respect to one another and a third jaw member disposed between the first and second jaw members, the first and second jaw members configured to be controllably movable from a first position, wherein the first and second jaw members are disposed in spaced relation relative to the third jaw member, to a second position, wherein the first, second and third jaw members cooperate to grasp tissue therebetween; and a cutting member disposed on an upper surface of the third jaw member, the cutting member configured to cut tissue disposed between the first and second jaw members.
 13. The end-effector assembly of claim 12, wherein the cutting member outwardly extends from the upper surface of the third jaw member.
 14. The end-effector assembly of claim 13, wherein the cutting member includes a cutting edge.
 15. The end-effector assembly of claim 12, wherein the cutting member is an ultrasonic member configured to treat tissue.
 16. The end-effector assembly of claim 12, wherein the third jaw member is configured to be controllably movable from a first configuration, wherein an upper surface of the third jaw member is substantially coplanar with upper surfaces of the first and second jaw members, to a second configuration, wherein the upper surface of the third jaw member is disposed below a plane defined by the upper surfaces of the first and second jaw members.
 17. The end-effector assembly of claim 12, wherein the third jaw member is configured to be controllably movable from a first configuration, wherein an upper surface of the third jaw member is substantially coplanar with upper surfaces of the first and second jaw members, to a third configuration, wherein the upper surface of the third jaw member is disposed above a plane defined by the upper surfaces of the first and second jaw members.
 18. The end-effector assembly of claim 12, wherein the first and second jaw members are configured to be controllably movable towards the third jaw member to progressively tension tissue overlying the upper surface of the third jaw member. 